Objective To summarize the imaging manifestation and identification of ectopic pancreas (EP), so as to improve clinicians and radiologists’ knowledge of EP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate and avoiding unnecessary surgery. Methods Combined with clinical experience and relevant literatures in recent years, the histopathology, common imaging manifestations and main differential diagnosis of ectopic pancreas were summarized. Results EP is a rare congenital developmental anomaly of pancreas, the most common location is the upper digestive system. At present, the commonly used imaging technology is computed tomography. The imaging findings of ectopic pancreas were similar to those of normal pancreas, and its density and enhancement characteristics were related to its histopathological composition. The specific signs of ectopic pancreas include “central umbilical sign” “ductal structure” and “flat/adherent sign”. Heterotopic pancreas should be differentiated from submucosal tumor of gastrointestinal tract. Conclusions The imaging findings of EP have certain characteristics. For some cases with atypical imaging findings, imaging diagnosis is difficult.
ObjectiveTo investigate the management of hepatic vein (HV) in patients with functional single ventricle (FSV) and separate hepatic venous drainage (SHVD) undergoing total cavopulmonary connection (TCPC) and evaluate this kind of surgery.MethodsThe clinical data of 32 consecutive patients with SHVD who underwent modified TCPC operation from August 2005 to January 2017 in our center were retrospectively analyzed. There were 25 males and 7 females with an average age of 2-19 (8.0±5.0) years and body weight of 11-66 (25.4±15.8) kg.ResultsThere were 20 patients with heterotaxy syndrome and 12 patients with other types of FSV. SHVD was diagnosed preoperatively in 27 patients, among whom 20 patients were connected by intra-extracardiac Gore-Tex conduit, and the other 7 patients were connected by extracardiac Gore-Tex conduit. Because of the missed diagnosis of SHVD, the other 5 patients showed severe decrease of blood oxygen saturation in the early postoperative period and underwent re-operation soon. The postoperative blood oxygen saturation was 92.0% (90.0%, 96.0%), central venous pressure was 10-23 (15.5±3.5) mm Hg, mechanical ventilation assisted time was 16.0 (7.5, 24.0) h, and ICU stay time was 3.0 (2.0, 5.5) d. There were 3 early and 1 late deaths.ConclusionIntra-extracardiac conduit is an effective and feasible modified TCPC operation for patients with FSV and SHVD, while the surgical details need to be formulated in combination with individual anatomical structure. Preoperative missed diagnosis of SHVD must be avoided. Otherwise, after TCPC, a large amount of stealing blood from HV with low circulation pressure into atrium would lead to unacceptable hypoxemia.
Intrahepatic ectopic splenosis is rare and lacks typical clinical and imaging features. We analyzed the clinical, pathological, and imaging characteristics of a patient with intrahepatic ectopic splenosis admitted to the Guangzhou First People’s Hospital in combining with literature review. The aim of case analysis is to enhance comprehension of the disease and provide a reference for clinical doctors in diagnosis.
Objective To investigated the distribution of epidermal stem cells in rat fullthickness wound tissues during the wound healing process and toelucidate the roles of epidermal stem cells in wound repair in vivo.Methods Eighty circular fullthickness wounds were produced on both sides of the back in 20 male Wistar rats labeled with BrdU 60 days previously (4 wounds in each rat). BrdU, β1 integrin and keratin 19 (K19) were employed to determine the epidermal stem cells with SP immunohistochemical methods, and the epithelialization wasdetermined with routine histological methods of HE staining on the 3rd, 7th, 14th, and 21st days after operation.Results No cells with positive immunostaining for β1 integrin, K19 and BrdU were found in granulation tissue of woundin both groups during the healing process. However, a few scattered β1 integrin and K19 positive cells were found within the stratum spinosum and stratum granulosum of the epidermis on the wound edges on the 3rd day post-injury. And these positive cells gradually became more and more in number, and mostly concentrated on the border of wound edges till the wounds healed. In addition, the number of positive cells for β1 integrin and K19 in the infected wounds was less than that in non-infected wounds. These positive cells for β1 integrin and K19 staining on the wound edge were also positively stained with BrdU in the cellular nuclei. Conclusion The above results indicate that ectopia of epidermal stem cells present a major function during wound epithelialization.
ObjectiveTo summarize the research progress of heterotopic ossification of the elbow joint after trauma. MethodsThe recent domestic and foreign literature concerning heterotopic ossification of the elbow joint after trauma was analysed and summarized. ResultsThe mechanism of heterotopic ossification of the elbow joint after trauma is mainly related to bone morphogenetic protein signal transduction disorder. Now there are many treatments of heterotopic ossification, including non-surgical treatment, prevention, and surgical treatment. Non-surgical treatment and prevention mainly aim at patients who have no elbow heterotopic ossification or who have mild limited elbow motion because of elbow heterotopic ossification after trauma, including drug therapy, radiation therapy, Chinese medicine therapy, and rehabilitation treatment. For patients with invalid non-surgical treatment, choosing surgical treatment is a must. Surgical treatment includes surgical resection, arthroscopic resection, and joint replacement, priority should be given first to surgical resection. ConclusionHeterotopic ossification of the elbow joint is common and there is not a recognized standard treatment, comprehensive use of non-surgical treatment and surgical treatment is the future direction.
Objective To study the effect of motor nerve implantation after ectopic transplantation of skeletal muscle on nerve regeneration in rat. Methods Sixty Sprague-Dewley male 8 monthold rats were randomly divided into 3 groups: control group,in situ implantation group and ectopic transplantation group. In control group, obturator nerve controlling right gracilis was cut off. In in situ implantation group, the right gracilis was cut off and replanted to its original site, and the obturator nerve was implanted to the muscle. In ectopic transplantation group, the right gracilis was cut off and transplanted to the muscle of the left leg, and the obturator nerve was implanted to the muscle. After 25 weeks, the neurophysiological information was collected through electromyography and the weight of the muscle was measured. Results The potentialwithout control of the nerve existed in control group. There were no significant differences in latency, amplitude and conduct velocity betweenin situ implantation group and ectopic transplantation group(Pgt;0.05).The atrophy of gracilis was dominant incontrol group, the weight of the muscle was 158.0±19.3 mg. The weights of the muscle were 509.6±14.5 mg in ectopic transplantation group and 516.8±12.7 mg in in situ mplantation group, showing no significant difference (P＞0.05). The weights of the muscle in in situ implantation and ectopic transplantation group were larger than that in control group, showing significant difference(P＜0.05). Conclusion Motor nerve implantation after ectopic transplantation of skeletal muscle could prevent the atrophy of the muscle and resume partial function of nerve.
Objective To summarize the experience of the surgical treatment of total anomalous pulmonary venous connection (TAPVC) in 31 cases，so as to elevate the operative effect. Methods The total corrected operation under moderate hypothermic cardiopulmonary bypass were performed in 31 cases with TAPVC. Site of drainage was supracardiac (n=16),cardiac(n=13)and mixed(n=2). Other accompanying congenital cardiac malformations were diagnosed such as atrial septal defect(n=31), patent ductus arteriosus(n=4), pulmonic stenosis(n=1), mitral regurgitation(n=1), tricuspid regurgitation (n=15)，etc. Results No hospital death was observed in the early period of operation (30 d). Complication occurred in 8 cases (25.8%), such as paroxysm of nodal rhythm(n=1), Ⅰ° atrial ventricular block(n=1), frequently atrial premature beats and paroxysm of auricular tachycardia(n=1),pulmonary infection(n=2),atelectasis(n=1), pneumatothorax (n=1), left diaphragmatic paralysis and pulmonary infection with tracheal reintubation (n=1),etc. All of them discharged after active therapy. All of 31 cases was followed up, followup time was 2.8±1.5 years. 30 cases were living (96.7%) and 1 case died of heart failure 8 months after operation. 2 cases had auricular arrhythmia with a bad medical effect. 28 cases(93.3%) had normal heart function and they could work and live normally after discharged. Conclusion Surgical procedure should be based on individual abnormality for TAPVC.Surgeons should take care not only of the stenosis of anastomotic stoma,but also of the arrhythmia after operation.Satisfied correction of the abnormality is important and the curative effect of those cases is approving.